Birth trauma, you could call it that. My first daughter was stillborn at full-term in December of 2012. I went into labor and delivery that night expecting to soon meet my little girl only to be told by the doctor while sitting in front of a still and silent ultrasound that there was, “No heartbeat”.

Crushed, heartbroken, devastated and numb, I fought for my life when I delivered her, because the infection that killed her, it could have taken my life too. I think it’s safe to say that birth trauma is what happened during the silent entrance of my daughter’s body into the world.

Seven months later I was pregnant again, terrified beyond what doctors and therapists would think was just a normal grief. As my belly grew with my daughter inside, both of us getting closer and closer to her due date, I would panic almost daily. At night I would wake in up in sweats as nightmares of not being able to feel her move would haunt me. Then I would spend an hour at three in the morning making sure she would move, making sure she was alive, because there were days when my anxiety convinced me that she had died too. I would mentally prepare myself to go to yet another ultrasound appointment and once again hear those dreaded words, “I’m sorry. There is no heartbeat.”

While pregnant after the death of my first daughter, it was almost impossible to get through my job everyday. I was always worried that she might have stopped moving or that she died while I was engrossed in a work task. The fear engulfed me. I frequently needed to step out of meetings to splash water on my face and poke at my baby to count her kicks and make sure she was still there, still moving, still alive. I also took extra ‘sick’ days just to manage my anxiety, to try to relax at home and take it easy, which proved challenging.

Then on the days that I would make it through work I would come home in the evening and break into tears of fear as I lay sobbing on my bed. My husband held me as I cried, crying with me, and I would scream between my wails, “I can’t do this! I can’t do this anymore!”

Being pregnant again after a loss is like living inside your trauma, which, unfortunately, is your own body that you cannot escape from for nine months. It’s torture, trying not to let your fears and anxiety control you. However, now you know; you know all that can go wrong. You know you are not guaranteed this baby, just like you weren’t guaranteed the one who died

Some might think that once the baby arrives safe and healthy relief would settle in, and the anxiety and worry would disappear. However, this did not happen for me. The anxiety increased daily a few months after my living baby was born.

In the hospital, two days after she was born, I had a mental break down. I was obsessed with my health, afraid that if I breastfed her I would somehow give her a new infection, and that my body would cause her to die too. Irrational fears like this one flooded me, and only proceeded to get worse when we went home. Yes, I was relieved and happy that my daughter was here, that I finally got to bring home a baby after 18 months of being pregnant. But the irrational thoughts kept creeping in. I would stay up late at night, unable to fall asleep because I was convinced the world was going to end due to the eruption of the super volcano in Yellowstone. I would seek reassurance from all my family members around this issue, and most of them looked at me like I was crazy.

In the days and weeks after my irrational thoughts had taken over, I visited the doctor and talked to my therapist about my postpartum anxiety. I learned that I was at a higher risk for postpartum mood and anxiety disorders because of the birth trauma from my first daughter’s stillbirth.

Slowly, over time with the help of my doctor and therapist, I learned that breastfeeding my baby would not kill her, as I thought it would. When done with breastfeeding, we discussed medication to address the anxiety, which ultimately was the right choice of treatment for me, along with continuing talk therapy that utilized dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) techniques.

My daughter is now 11 months old. Each day that passes I seem to have less and less anxiety. I’m still going to therapy, and I’m still taking medications, and thanks to these treatments I get to enjoy more moments with my daughter and use this second chance at motherhood as a time to heal. Even if anxiety continues to be my companion I now know how to keep her at bay.

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Lindsey Henke is the founder and editor of Pregnancy After Loss Support, writer, clinical social worker, wife, and most importantly a mother to two beautiful daughters. Tragically, her oldest daughter, Nora was stillborn after a healthy full-term pregnancy in December of 2012. Since then, she has turned to writing on her blog, Stillborn and Still Breathing, to soothe her sorrow and has found healing in giving voice to her grief. Lindsey is also a monthly contributor to Still Standing Magazine and was featured as Pregnancy and Newborn Magazine’sKnocked Up Blogger during her pregnancy with her second daughter, Zoe who was born healthy and alive in March of 2014.

Knowing is half the battle. I found this to ring true in my experience with managing my mental illness during my pregnancies and postpartum.

I was diagnosed with Bipolar Type 1 in 2006. It took over a year for me to find the right psychiatrist, the right combination of medications, and the right techniques through therapy to allow me to begin to manage an illness which had taken me and my family completely by surprise. After months of anguish over what was working and what wasn’t, we finally found a medication that stabilized me and I started to feel pieces of my old self emerging from the darkness.

Once I had been stable for about a year, my husband and I decided we were ready to start a family. I was scared of a recurrence of my illness, but wanted to be a mom more than anything, so we started trying and I was able to get pregnant rather quickly. Unfortunately, our joy was fleeting as I experienced an early miscarriage and had to have a D&C. I was afraid that the medication I had been taking for my bipolar disorder caused the miscarriage, so I convinced my psychiatrist to allow me to taper off the med so that we could try again after I healed from the surgery.

We became pregnant again fairly soon after, and since I was doing so well off the medication and had no recurrance of symptoms, my doctor continued to see me as a patient but allowed me to stay off my medication for the duration of the pregnancy.

This was a terrible decision on both our parts, but I didn’t realize this at the time. Four weeks after delivering my son I experienced a severe episode of postpartum psychosis and had to be hospitalized for a week. It was arguably the worst week of my life, having been ripped from my child, having to abruptly stop nursing, and it took an incredible toll on me both physically and emotionally.

I was stabilized quickly by the team of doctors at the hospital by resuming my course of medication I had been on before my pregnancy. The recovery from the trauma of being taken away from my newborn for a week would take much longer.

I learned through my postpartum psychosis episode that my triggers are: lack of sleep and lack of medication in my bloodstream. These two facts would prove essential to me creating a much more positive postpartum experience with my second child. But not without another lesson first.

Once stable again after my PPP hospitalization, my husband and I began to talk about completing our family with one more baby. Even with my three hospitalizations (two before our first child and the PPP episode), I still didn’t know enough about my illness to know that the benefits of me staying on my medication during the pregnancy and exposing the fetus to the medication, although not the most ideal situation, far outweighed the risks of not being on medication at all given this was one of my top two triggers.

Doctors can advise patients, but it’s up to the patient to follow through with the prescribed recommendations. My doctor had agreed to let me stay off medication during the first trimester due to a heart defect risk, but after week 12 we decided I would go back on my medication for the duration of the pregnancy.

Tapering off my medication in just week 5 of the pregnancy, combined with my excitement and mounting loss of sleep over how excited I was to see those two pink lines on the pregnancy test, landed me in the psych ward again. My baby was barely the size of an orange seed and I had to be hospitalized for almost a week and put on antipsychotic medication to bring me down from the mania I had been struck with.

Because of lack of sleep and lack of medication. Two things I learned I could control.

Recovery from that episode took months; experts say that each subsequent episode is more difficult and takes longer to recover from, and I’ve found this to be true. But I emerged from that setback a much more informed and capable mother, ready to truly manage my illness so that it did not cause me and my family any further pain.

My husband and I talked about how we could handle my postpartum period differently with our second child, and we made plans to take charge over my triggers so that I could stay in recovery long-term. I stayed on my medication for the entire rest of the pregnancy and beyond because my medication kept me stable. We made plans that I would bottle-feed and my husband would take over the middle-of-the-night feedings between 2am – 5am so that I could get a long stretch of sleep at night, keeping my nocturnal clock in check.

I’m not saying it was easy. But my postpartum period with my second child was so much more enjoyable and relaxed compared to my first because I took the upper hand over my triggers. With my family’s support, I made it through. And I continue to keep a firm grip on my dedication to the medication that keeps me stable and getting the appropriate amount of quality sleep each night so that I can stay steady on my recovery path.

Bipolar disorder is a condition I’ll live with for the rest of my life. Learning my triggers and techniques which allow me to stay on top of them so they don’t throw me into a manic episode has been a learning process, but it is one which has empowered me to live well even with a mental health disorder.

When we found out I was pregnant (far sooner than we had planned), my husband and I decided right away that no matter what course of treatment we decided upon after speaking with my doctors, our number 1 priority was my mental health. Still absorbing the shock, I remember my husband standing in our bedroom with his fingers lacing their way through mine, saying, “Health and wellness, Addye. That’s our focus, ok? Your health and wellness. No guilt, no shame, no matter what happens. YOU and your health are what’s most important. We’ll do whatever it takes. We’ll get through this together. I promise. Let’s do this.” I’m pretty sure I was fighting back tears and a whopping dose of fear in that moment as I high fived him and agreed: We could do this. I could do this.

And I did. I have. I’ll be a year postpartum next month, and as I watch my youngest son crawl into the room he shares with his two older brothers, I think back to that moment in my bedroom and feel proud of that promise we made, and the treatment option I chose.

Given my previous history with PPD, the nature of my illness, and the increased risk of relapse I faced because I have bipolar disorder, we decided staying on two out my three medications was what health and wellness would look like for me…as well as for the baby and the rest of my family.

That was my choice, but I know many other mothers with bipolar disorder who opted to go without their medications during their pregnancies and remained healthy throughout. No matter what course of treatment you and your care team decide upon, the important thing to remember is that you DO have options. There’s nothing I hate more (aside from stigma) than coming across an article on the internet that gives women with bipolar disorder incomplete information regarding their treatment options during pregnancy and breastfeeding, doesn’t point to what resources they can utilize to make informed decisions, and doesn’t tell them how they can navigate the unique challenges they’re faced with.

So let’s talk about how to do that, shall we? (This post is going to a bit long, but bear with me, I believe what I’m sharing with you is important)

1. Build Your Care Team, Create a Treatment Plan

I cannot stress the importance of this enough: You MUST have people on your medical team who have experience in treating pregnant women with mood disorders. Think of this as your Dream Team. People you want on this team are your OB, your psychiatrist, therapist (if you have one), and a pediatrician. It’s possible your obsectrician will also want a reproductive psychiatrist and maternal fetal medicine doctor on your team as well, especially if their experience on this front is minimal. Thankfully, my OB had extensive experience with caring for women with bipolar disorder during their pregnancies and knew pretty much everything that’s out there regarding medication use during pregnancy and breastfeeding. He was up to date on the latest research available and proved to be my most invaluable resource on my care team. Seriously, he’s the one who gave me the confidence that all would be well, and that choosing to stay on at least two of my medications was a safe and healthy choice. Both he and my psychiatrist spent a lot of time going back and forth, weighing the risk vs. benefit of staying on meds or going without, and although they disagreed on a few minute points, they ultimately decided staying on medication would be healthiest for me, and ultimately, baby.

Also be sure to find a pediatrician to consult. You’ll need one anyway after the baby is born, so you might as well find one who knows about medications, postpartum mood disorders, AND does depression screenings at well visits. (Our pediatrician does and it has been incredibly helpful to me this past year.)

Finally, ensure that the team you build has your mental health as their top priority. As soon as a woman becomes pregnant, the focus tends to immediately shift toward the health of the baby and stay there. In the past, I’ve dealt with OB’s who only cared about how I was doing physically and what impact any physical conditions I had would have on my baby in utero. Not once did they focus on my mental well-being, let alone have it guide my prenatal care. Listen: I completely agree that baby’s health is a priority. I do. But I’m going to just come right out with it and say that a mother’s mental health is what’s most important and should be the foundation of her prenatal care, and if no one on your team shares in that philosophy? They shouldn’t be on your team or in charge of you and your baby’s care. Period. Same goes for the person treating your mental health condition. My first psychiatrist through the VA was woefully uninformed and unhelpful when I told her I was pregnant. It took a lot of pushing, but I was finally able to have my care transferred to a psychiatrist with a background in pharmacology and reproductive psychiatry, and it made a significant difference in my overall care.

2. Communicate and Advocate

Everyone on your care team should be in constant communication with you and each other through every phase of your pregnancy and delivery. They should also be able to come to an informed consensus (with you) about your treatment. There is nothing worse than having two of your doctors at an impasse over a part of your treatment plan because they just disagree. It’s incredibly frustrating and the last thing you need to be worried about. If this happens, don’t be afraid to speak up and advocate for yourself, reminding them that they are there to help care for you and your baby, and you need them to work together.

Always be open and honest with your care team about what you’re feeling and experiencing throughout your pregnancy, so they know how to help you as soon as possible. Part of my treatment plan involved staying off of my mood stabilizer during my first trimester, but remaining on my anti-depressant. At 11 weeks, I called my OB and told him my mood was starting to take a nosedive and I was worried about a depressive episode. He moved my NT ultrasound scan up to the start of week 12, and as soon as he reviewed the results, gave me the all clear to start back on my mood stabilizer.

3. Do Your Own Research, Knowledge is Power

There are books out there on medication use during pregnancy and breastfeeding and the variety of treatment options available for women in our situation-get your hands on them and read as much as you can, being sure to talk with your care team about what you learn as you do. When researching my treatment options and discussing them with my team, books I read included Pregnant on Prozac by Dr. Shoshanna Bennet, Medications and Mother’s Milk 2012: A Manual of Lactational Pharmacology by Dr. Thomas Hale, and The Complete Guide To Medications During Pregnancy and Breastfeeding: Everything You Need to Know To Make the Best Choices for You and Your Baby by Carl P. Weiner MD and Kate Rope. I also read everything I could on the MGH Center for Women’s Mental Health blog, which has a wealth of information on research studies and how to use their findings to make informed treatment decisions with your clinician.

4. Create a Birthplan That Takes Your Mental Health Into Account

Initially, I considered going without pain meds for my delivery. I read all I could about natural child birthing methods, and had it in my mind that I’d hypnobirth my way through labor and delivery, even if I wound up crying uncle and utilizing some form of pain medication. But at 28 weeks, I landed in L&D with contractions that wouldn’t stop without magnesium. In fact, they didn’t really stop the rest of my pregnancy. I contracted every day of my third trimester without ever dilating more than 2 centimeters. Previous experience reminded me that neither of my labors with my older two progressed without intervention, despite having intense, painful contractions that were off the charts for a week. Looking back, I’m positive this contributed to the panic and anxiety I had during both deliveries and afterward. With this third go around, I was miserable, exhausted, starting to have anxiety attacks, and was starting to cycle between nesting induced hypomania and depression.

At week 38 I told my OB I was done and worried that continuing would put me over the edge and trigger a depressive episode-and I hadn’t done all of this preventative health and wellness work to be in a dark place when my baby boy was placed on my chest. I knew my limits, and wanted a bit more control. I wanted an induction. He agreed, and a week later I was in the delivery room smiling and laughing as I stared lovingly at my newborn-100% anxiety free. It was a calm and beautiful experience and in my opinion, gave me the strong start postpartum I needed.

Having the love and support of friends, family, and your partner is so important. Lean on them when you need to, and don’t be afraid to ask them for help. Inform them of ways they can be a support to you. My friends (fellow Warrior Moms) and my husband did an amazing job of supporting me during my pregnancy and this past year. I couldn’t have made it without them to call, text, and share this experience with. A therapist can also be an invaluable resource to you during this time; they can help you process all you’re experiencing and develop coping strategies for managing your postpartum period. Consider finding support online in a private forum for pregnant and new moms with mood disorders (like Postpartum Progress’ Smart Patients Forum or the #PPDChat private group on Facebook), or find what’s available to you locally through organizations like NAMI or DBSA.

6. Self Care

Try to find ways to incorporate rest into your day as much as possible, even if you already have other children. Do not go without sleep. Create manageable to-do lists, and reconstruct your expectations about how much you can get done each day-especially if you’re working. Practice deep breathing exercises, and engage in physical activity that is both safe for you and baby and feels good. Engage in activities that are calming and nourish your soul-even if it’s binge watching your favorite show on Netflix. Keep track of your mood either in a journal, or with a mood tracking app on your phone; this will help you be able to communicate to your care team and support network how you’re doing. (I use iMood Journal) Prenatal massage, mani/pedis…whatever self-care looks like and is for you, be sure you do it and do it as much as possible.

I hope this is helpful and gives you a good starting point for creating a plan that works for you. Remember-You have options when it comes to treatment. You can do this. I promise. You got this, mama.

Parenthood is, in a lot of ways, just a bunch of sleepless nights bleeding into long days. That sounds kind of bleak, but I’m not sure there’s a more complex state of being than that of being a parent. You’re always being pulled in multiple directions and overcome with conflicting emotions. And, honestly, I’m not sure that it’s ever as hard as it is in the first gritty-eyed months of having a freshly baked baby.

Throughout Archer’s first year, inertia carried me. Once I went back to work, the force of my footsteps was the only thing that propelled me forward. Daycare. Work. Pump. Coffee. Pump. Lunch. Pump. Daycare. Home.

And through it all, I felt alone.

Physically, distance crushed me. I was half a continent away from my family. Emotionally, disconnect destroyed me. Most of my friends did not have children of their own. If I could have articulated how abandoned I felt, my words would have been scarcely a whisper.

But, again, let’s rewind.

Breastfeeding came easily to Archer and me. Despite his time in the NICU, he latched quickly and nursed like a champion. The emotional trauma of his tumultuous birth experience was healed by our outstanding nursing relationship.

Nursing sustained us. It bonded us. It provided just the right dose of feel-good hormones to shield me from the undercurrent of isolation that tried so insidiously to steal my joy. When we weaned, the loneliness reached up from the deep below and quietly pulled me down.

Without realizing it, my body and mind were being realigned as Archer nursed less. The chemicals in my brain like tectonic plates, slowly and imperceptibly shifting to create entirely new and unrecognizable continents within my psyche.

I left my job to pursue a freelance writing and marketing career and I spent each day deafeningly alone. Just me and my deadlines and – I know now – my depression.

Despite having solid support systems and amazing friends, I was borderline non-functional by the time I admitted that I needed help. Depression is a liar and she told me that no one knew my plight – that such loneliness was the result of being undesirable by friends and family alike.

In my first postpartum counseling session, I sat across from my psychiatrist and psychologist – both specially trained to work with mothers with mood disorders – and told them how impossibly isolating motherhood was. My doctor pushed up his glasses, looked me in the eye, and said, “Liz, I am not here to belittle your experience, but I want you to know that every mother who has ever sat in that chair has said those same words.”

Now, let’s fast forward.

With a diagnosis of “post-weaning depression,” I restarted on my Lamictal and recovered, once again, quickly. And, again, we reveled in my stability.

Archer became our co-pilot on a new adventure and we moved from Baltimore to Germany for a three year assignment with my husband’s job. In our time here, the isolation of motherhood combined with the isolation of ex-pat life to create a sort of mecha-loneliness that has tried to cut me down many times. If I’m being honest, sometimes, it has succeeded.

Enduring a rough pregnancy an ocean away from family and friends did little to quell the rising tide of lonesomeness. Late night nursing and long days working ignite sparks of heartache that occasionally rekindle the flames of alienation.

But, in my worst days, I rewind to my psychiatrist’s office and remember that my isolation is not a unique condition of my experience with motherhood.

You see, motherhood is a weird thing in that many mothers experience the same things, but in different ways. There are times when all of us feel alone. Motherhood, on some level, breeds some amount of isolation. But, in that isolation, we are – in a twisted way – brought together.

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Disclaimer

Postpartum Progress exists to provide peer-to-peer support. The information on this site is for educational, advocacy purposes only. It is not intended to diagnose or treat any medical or psychological condition. Please consult your own health care provider for individual advice regarding your specific situation and needs.